The prevalence of bilateral hearing loss in the United States in 2019: a small area estimation modelling approach for obtaining national, state, and county level estimates by demographic subgroup.

Background: The goal of this study was to re-estimate rates of bilateral hearing loss Nationally, and create new estimates of hearing loss prevalence at the U.S. State and County levels. Methods: We developed small area estimation models of mild, and moderate or worse bilateral hearing loss in the U.S. using data from the National Health and Nutrition Examination Survey (2001-2012, 2015-2018), the American Community Survey (2019), Census County Business Patterns (2019); Social Security Administration Data (2019); Medicare Fee-for-Service and Advantage claims data (2019); the Area Health Resources File (2019), and other sources. We defined hearing loss as mild (>25 dB through 40 dB), moderate or worse (>40 dB), or any (>25 dB) in the better hearing ear based on a 4-frequency pure-tone-average threshold, and created estimates by age group (0-4, 5-17, 18-34, 35-64, 65-74, 75+), gender, race and ethnicity, state, and county. Findings: We estimated that 37.9 million (95% Uncertainty Interval [U.I.] 36.6-39.1) Americans experienced any bilateral hearing loss; 24.9 million (95% U.I. 23.6-26.0) with mild and 13.0 million (95% U.I. 12.1-13.9) with moderate or worse. The prevalence rate of any hearing loss was 11.6% (95% U.I. 11.2%-12.0%). Hearing loss increased with age. Men were more likely to have hearing loss than women after age 35, and non-Hispanic Whites had higher rates of hearing loss than other races and ethnicities. Higher hearing loss prevalence was associated with smaller population size. West Virginia, Alaska, Wyoming, Oklahoma, and Arkansas had the highest standardised rate of bilateral hearing loss, and Washington D.C., New Jersey, New York, Maryland, and Connecticut had the lowest. Interpretation: Bilateral Hearing loss varies by State and County, with variation associated with population age, race and ethnicity, and population size. Geographic estimates can be used to raise local awareness of hearing loss as a problem, to prioritize areas for hearing loss prevention, identification, and treatment, and to guide future research on the hearing loss risk factors that contribute to these differences. Funding: CDC's National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health.

The effect of occupational status on health: Putting the social in socioeconomic status.

High status occupations support positive health outcomes through providing access to both material and psychosocial resources. However, common measures of occupational status such as occupational prestige scores fail to capture cultural esteem that certain occupations can provide because they are primarily associated with the material dimensions of status, like income. Drawing on Weberian conceptions of status and a body of social psychological research on the measurement of cultural meaning, we argue that measuring people's ratings of their occupations on three dimensions-evaluation (good/bad), potency (powerful/weak), and activity (active/inactive)-provides an occupational status indicator that more fully captures psychosocial resources like esteem that are associated with health than more commonly used occupational prestige scores. Using a nationally representative longitudinal health and wellbeing survey of 940 American law enforcement officers collected between 2020 and 2022, we evaluate the predictive ability of evaluation, potency, and activity (EPA) ratings across thirteen measures of health and wellbeing. We find that EPA ratings were significant and positive predictors of eleven of thirteen outcomes with stronger effects for mental health outcomes compared to physical health outcomes. EPA ratings were more predictive than more commonly used occupational prestige scores. We conclude that EPA ratings are better predictors of health outcomes than occupational prestige scores and so may allow health researchers to better understand the relationship between occupational status and health.

Older adults' knowledge and perception of fall risk and prevention: a scoping review.

BACKGROUND: Falls are a leading cause of injury and mortality among older adults. While multiple strategies are effective at reducing fall risk, uptake is low. Understanding how older adults think about fall risk and prevention activities can inform outreach initiatives and engagement. METHODS: We systematically searched PubMed, SCOPUS and Google Scholar for articles published between January 2015 and April 2023. Studies were eligible if they reported on knowledge or perception of fall risk and/or prevention among community-dwelling older adults. RESULTS: We included 53 studies from 20 different countries. Over half of the studies used qualitative methods, 19 used quantitative, and three used mixed methods. Most of the older adults could identify some fall risk factors and the consequences of falls. However, many older adults did not view themselves as at-risk for falls. Some older adults consider falls an inevitable part of ageing, while others believe that falls can be prevented. Cultural context may play a role in shaping these beliefs. Several studies reported on older adults' experiences and the perceived barriers and facilitators of participating in fall prevention activities. CONCLUSION: Improving the accuracy of older adults' perceptions of their own fall risk and highlighting the fact that many falls are preventable are two key messages that may help motivate older adults to take action to prevent falls. Older adults cite their healthcare provider as a trusted source of prevention information, and clinicians can leverage this opportunity to inform and motivate older adult patients about fall prevention.

Association Between Social Determinants of Health and Examination-Based Vision Loss vs Self-reported Vision Measures.

Importance: Recent evidence suggests that social determinants of health (SDOH) affect vision loss, but it is unclear whether estimated associations differ between clinically evaluated and self-reported vision loss. Objective: To identify associations between SDOH and evaluated vision impairment and to assess whether these associations hold when examining self-reported vision loss. Design, Setting, and Participants: This population-based cross-sectional comparison included participants 12 years and older in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), participants of all ages (infants and older) in the 2019 American Community Survey (ACS), and adults 18 years and older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Exposures: Five domains of SDOH that are based on Healthy People 2030: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Main Outcomes and Measures: Presenting vision impairment of 20/40 or worse in the better-seeing eye (NHANES) and self-reported blindness or serious difficulty seeing, even with glasses (ACS and BRFSS). Results: Of 3 649 085 included participants, 1 873 893 were female (51.1%) and 2 504 206 were White (64.4%). SDOH across domains of economic stability, educational attainment, health care access and quality, neighborhood and built environment, and social context were significant predictors of poor vision. For example, higher income (poverty to income ratio [NHANES]: OR, 0.91; 95% CI, 0.85-0.98; [ACS]: OR, 0.93; 95% CI, 0.93-0.94; categorical income [BRFSS:<$15 000 reference]: $15 000-$24 999; OR, 0.91; 95% CI, 0.91-0.91; $25 000-$34 999: OR, 0.80; 95% CI, 0.80-0.80; $35 000-$49 999: OR, 0.71; 95% CI, 0.71-0.72; ≥$50 000: OR, 0.49; 95% CI, 0.49-0.49), employment (BRFSS: OR, 0.66; 95% CI, 0.66-0.66; ACS: OR, 0.55; 95% CI, 0.54-0.55), and owning a home (NHANES: OR, 0.85; 95% CI, 0.73-1.00; BRFSS: OR, 0.82; 95% CI, 0.82-0.82; ACS: OR, 0.79; 95% CI, 0.79-0.79) were associated with lower odds of vision loss. The study team identified no differences in the general direction of the associations when using either clinically evaluated or self-reported vision measures. Conclusions and Relevance: The study team found evidence that associations between SDOH and vision impairment track together when using either clinically evaluated or self-reported vision loss. These findings support the use of self-reported vision data in a surveillance system to track trends in SDOH and vision health outcomes within subnational geographies.

Food security and diet quality in a racially diverse cohort of postpartum women in the USA.

Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (ß: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (ß: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.

SNAP and Cardiometabolic Risk in Youth.

Increasing numbers of children and adolescents have unhealthy cardiometabolic risk factors and show signs of developing metabolic syndrome (MetS). Low-income populations tend to have higher levels of risk factors associated with MetS. The Supplemental Nutrition Assistance Program (SNAP) has the potential to reduce poverty and food insecurity, but little is known about how the program affects MetS. We examine the relationship between SNAP and the cardiometabolic risk factors in children and adolescents using regression discontinuity to control for unobserved differences between participants and nonparticipants. We find that SNAP-eligible youth who experience food insecurity have significantly healthier outcomes compared to food-insecure youth just over the income-eligibility threshold. Our findings suggest that SNAP may be most beneficial to the most disadvantaged households. Policy makers should consider the broad range of potential health benefits of SNAP.

US state variations in food bank donation policy and implications for nutrition.

Food insecurity has increased dramatically in 2020 as a result of the COVID-19 public health and economic crisis. Many more families in the United States are turning to the charitable food system to help meet their needs. However, little is known about the policies that influence food bank donations and whether they promote healthy food donations. The purpose of this study was to explore state variation in food donation policies and secondarily to assess whether policies promoted the donation of healthy foods and beverages. We reviewed donation policies for all states in the United States and Washington, DC (hereafter "states") in fall 2020. Two reviewers independently assessed donation policies using two legal databases; we reconciled discrepancies via team discussion. We then grouped them into 10 distinct categories based on common purpose and theme. We identified 252 state policies from 51 states. Policies fell into all 10 categories. The largest category was "liability protection," with all states having a policy in this category. The second largest category was date labeling; 32 states had requirements or policies restricting the donation of past-dated foods. However, across all categories, we found that only two policies explicitly promoted the donation of healthy foods and beverages. Although all states had some policies governing food donations, few promoted healthier foods and beverages. States could encourage healthy donations through policy to help ensure that all families have access to nutritious foods and beverages.

Timing of WIC Enrollment and Responsive Feeding among Low-Income Women in the US.

We examined associations between the timing of The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment and responsive feeding and assessed food security as a possible effect modifier. We used data from the nationally representative WIC Infant and Toddler Feeding Practices Study-2. Our sample includes women-infant dyads interviewed through the first 13 months of age (n = 1672). We dichotomized WIC enrollment as occurring prenatally or after childbirth. The responsive feeding outcome was feeding on demand versus feeding on schedule. We used covariate-adjusted logistic regressions. Of women, 61.8% had a high school education or less and 62.9% lived at 75% or less of the federal poverty guideline. The majority (84.5%) of women enrolled in WIC before childbirth. In unadjusted estimates, 34% of women who enrolled prenatally practiced responsive feeding, compared to 25% of women who enrolled after childbirth. We found no evidence of food security as an effect modifier. In adjusted estimates, women who enrolled in WIC prenatally had 78% higher odds of practicing responsive feeding (OR: 1.78, 95% CI: 1.16, 2.73), compared to women who enrolled after childbirth. Prenatal enrollment in WIC was associated with higher odds of responsive feeding. Future studies should examine how the timing of WIC enrollment relates to responsive feeding in older children and over time.

Do additional SNAP benefits matter for child weight?: Evidence from the 2009 benefit increase.

We know that youth who live in low-income households tend to have lower nutritional health outcomes-including higher rates of obesity-when compared to their higher-income counterparts. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. federal nutrition program and has been found to improve food security and to serve as an income support. It is less clear how SNAP may affect obesity in low-income youth. From a policy perspective, it is essential to understand how the largest federal nutrition assistance program influences the health of children and adolescents. We use the exogenous increase in SNAP benefits that was a part of the American Recovery and Reinvestment Act (ARRA) to identify how a change in benefits is linked with obesity in youth. We find evidence that the ARRA increase in SNAP benefits is associated with healthier weight outcomes in three of the four age groups examined. SNAP-eligible toddlers are less likely to be overweight and adolescents are less likely to be obese. These findings can help policy makers understand how additional SNAP benefits from the Families First Coronavirus Response Act may influence weight outcomes in children and adolescents.

An Increase in SNAP Benefits Did Not Impact Food Security or Diet Quality in Youth.

BACKGROUND: Low diet quality during childhood and adolescence is associated with adverse health outcomes later in life. Diet quality is generally poor in American youth, particularly in youth of low socioeconomic status. The Supplemental Nutrition Assistance Program (SNAP) is the primary safety net to help low-income households afford a healthy diet. Yet self-selection into the program creates challenges in estimating the relationship between SNAP and diet outcomes. OBJECTIVE: This study examined how the increase in SNAP benefits during the American Recovery and Reinvestment Act (ARRA) affected food security and diet quality in low-income youth. DESIGN: This analysis used a difference-in-differences design and data from the National Health and Nutrition Examination Survey 2007-2008 to 2011-2012 waves. PARTICIPANTS/SETTING: The sample included children and adolescents aged 2 to 18 years with household income ≤250% of the Federal Poverty Line. Food security and diet outcomes in SNAP-eligible youth (n = 2,797) were examined, with children in nearly SNAP-eligible households serving as a comparison group (n = 1,169). The diet quality analysis stratified the sample by age range. MAIN OUTCOME MEASURES: The study assessed food security and 6 dietary outcomes: 2 nutrients (sodium and fiber), 3 food categories (fruit, vegetables, and sugar-sweetened beverages), and 1 measure of overall diet quality (Healthy Eating Index 2010). STATISTICAL ANALYSIS PERFORMED: Logistic regression and linear regression were used to estimate the relationship between SNAP eligibility and child food security and diet. RESULTS: In unadjusted analysis, approximately 64% of SNAP-eligible children were food secure before ARRA and 73% were food secure while ARRA was in effect. Using logistic regression in a difference-in-differences framework, the ARRA SNAP benefit increase was not significantly associated with food security (odds ratio 1.37, P = 0.43). Diet quality of SNAP-eligible children was low, scoring a 46 out of 100 on the Healthy Eating Index 2010. Measures of diet quality did not significantly change from the pre-ARRA period to the ARRA period; this did not differ by age range. CONCLUSIONS: The increase in SNAP benefits during ARRA did not significantly impact food security or diet quality in low-income children and adolescents. Additional research to better understand how SNAP benefits impact dietary choice is warranted.

Food Bank Donations in the United States: A Landscape Review of Federal Policies.

Rates of food insecurity have increased substantially in the United States (US), and more families are turning to the charitable food system to help meet their needs. Prior studies have examined the nutritional quality of foods offered through food banks, but little is known about what government policies may shape the healthy food donation landscape. The purpose of this study was to review US federal policies that impact food and beverage donations to food banks and assess whether policies encourage healthy food donations. In spring 2020, two researchers independently reviewed federal food and beverage donation policies using predefined search terms in two legal databases. We identified six categories of policies based on the existing food donation literature and themes that emerged in the policy review. We identified 42 federal policies spanning six categories that addressed food and beverage donations to food banks. The largest category was "government programs," with 19 (45%) policies. The next largest category was "donation via schools," with 12 (29%) policies. However, no policies specifically addressed the nutritional quality of food donations. There is an opportunity for the federal government to strengthen food bank donation policies and improve the nutritional quality of donated foods and beverages.

Increasing Access to WIC through Discount Variety Stores: Findings from Qualitative Research.

BACKGROUND: Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits. OBJECTIVE: One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility. METHODS: To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels. RESULTS: Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff's prior WIC participation and customers' proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers. CONCLUSIONS: These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina's recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorization of discount variety stores: leveraging the private sector to modestly increase availability of healthy foods.

BACKGROUND: Many lower-income communities in the United States lack a full-line grocery store. There is evidence that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increases the availability of healthy foods in stores. One national discount variety store chain (DVS) that is often located in low-income neighborhoods became an authorized WIC vendor in 8 pilot stores. OBJECTIVES: The objective of this study was to evaluate how implementing WIC in DVS pilot stores affected sales of healthy, WIC-eligible foods. METHODS: We used DVS sales data and difference-in-differences regression to evaluate how WIC authorization affected sales of WIC-eligible foods in 8 DVS pilot stores, compared with 8 matched comparison stores. RESULTS: DVS added 18 new WIC-approved foods to become an authorized vendor. Results indicate that becoming a WIC vendor significantly increased sales of healthy, WIC-eligible foods that DVS carried before authorization. WIC implementation in DVS led to a 31-unit increase in sales of the original WIC foods per week on average (P < 0.01). Lower socioeconomic status, assessed using a summary measure, is associated with increased sales of WIC foods. Yet sales of non-WIC eligible foods (e.g., salty snack foods, candy bars, soda, and processed meats) were not affected by WIC authorization. CONCLUSIONS: Encouraging DVS stores to become WIC-authorized vendors has the potential to modestly increase DVS sales and the availability of healthy foods in low-income neighborhoods. If WIC authorization is financially viable for small-format variety stores, encouraging similar small-format variety stores to become WIC-authorized has the potential to improve food access.

The Supplemental Nutrition Assistance Program and Child Weight Status: A Review.

CONTEXT: The Supplemental Nutrition Assistance Program (SNAP) is a food assistance program that helps Americans afford a healthy diet. However, its influence on children's weight status is unclear. This review examined the evidence of the relationship between SNAP participation and child weight. EVIDENCE ACQUISITION: The following databases were searched: PubMed, EconLit, Web of Science, and the U.S. Department of Agriculture Economic Research Service. The last search was performed in October 2018. This systematic review gives a narrative synthesis of included studies. EVIDENCE SYNTHESIS: Twenty-three studies that examined the weight outcomes of children aged 2-18 years and SNAP participation were included. Eleven studies found no significant relationship between SNAP and child weight outcomes. Nine found that SNAP participation was associated with increased weight outcomes in certain subpopulations, and four found that SNAP was linked to a predicted decrease in weight outcomes in some subpopulations. However, many of these studies did not address a key methodologic challenge: self-selection. Of those that did, five found that SNAP participation was associated with an increased risk of being overweight and elevated weight in certain subpopulations. CONCLUSIONS: SNAP participation may help boys maintain a healthy body weight but can be a contributing factor in being overweight or obese in girls who are long-term participants, or who are already overweight. Food security and participation in multiple food assistance programs may be important modifiers. These findings are relevant to policymakers who are considering reducing SNAP funding or restructuring the program. Further research that utilizes strong designs is needed.